Radiology departments should lead their facility’s dose reduction efforts;

Facilities need and want effective solutions at a reasonable cost.

Our service is designed to achieve both. I developed this service for a health system in the mid-west. We enrolled some of their facilities in the DIR in 2013 and had excellent success reducing doses.

As the health system searched for solutions to TJC’s dose monitoring and incident identification requirements, it found plenty of companies willing to sell them very expensive solutions. We heard stories then, and still do today, about how many of those same facilities struggled to use them. Some have hired dedicated staff, increasing their costs even more. That is all well and good, particularly if the facility is a large health system with significant resources. However, that is not the world within which many of community-based facilities find themselves. Most community-based facilities need and want effective solutions at a reasonable cost. That is why I developed my program of using the facility’s DIR to do essentially the same thing. This mid-west health system estimated that our DoseID program is saving them $80,000 to $100,000 per year. And, best of all, it works well.

If you are unsatisfied with your current dose reduction efforts and/or dose monitoring platform, or your staff is challenged to understand and/or use the DIR, continue reading. Dose Registry Support Services can provide you with a program that works and is tailored to your specific needs – a program that supports you and your staff, keeps radiology at the center of the dose reduction efforts within your organization, and is extremely cost-effective with no long-term commitments.

Best of all, there is nothing to purchase up front and no long-term commitments. If you were to decide you no longer need our services, we simply stop.

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Dose Registry Support Services offers two distinct services:

DIR support

DIR set-up advice;

Exam name mapping and maintenance; and/or

Result review and recommendations.

TJC compliance (Dose ID)

Establishment of Expected Dose Ranges for every scanner protocol; and,

DIR support: Our DIR support service (#1 above) is essentially an ala carte service – the client chooses what they would like Dose Registry Support Services to do for them and what it will do themselves. Some facilities want Dose Registry Support Services to perform all DIR-related work, including mapping, remapping, and report review, while others may want to perform these tasks themselves, with us acting as advisors.

One of our goals is to teach local staff how to use the DIR so they can eventually perform the mappings and reviews after becoming comfortable with the process. Some facilities find their staff needs some guidance initially, but as they become more comfortable they are able to perform some or all of the tasks themselves. Others find it cost-effective to have us do most of the maintenance and initial review work.

Dose ID: Our Dose ID service (#2 above) provides a turn-key solution for meeting TJC’s requirement to establish dose ranges for every protocol and then identify any study whose total dose exceeded its expected range. We calculate expected ranges tailored to your facility by using your DIR data; expected ranges for TJC purposes are not based other facilities whose doses may have a completely different profile. This means we calculate dose incidents that truly represent studies that are abnormally high for your facility. The best part is that staff’s daily workflow remains unaltered.

Distance: Distance is not an issue: Our services can easily be provided remotely through email and video teleconferencing. Having said that, if a facility would like to set up an on-site meeting initially, or meet semi-annually or annually, we are able to arrange it.

Contracts: The best news is that there is nothing to purchase up front and no long-term commitments. If you were to decide you no longer need our services, we simply stop.

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Yesterday’s webinar titled Using the Dose Index Registry® to Implement an Effective Dose Monitoring Program was a resounding success with over 400 registrants attending, with an abundance of follow-up questions during the last 10 minutes.

During the webinar I shared several tips and hints for getting started using the DIR, as well as how Dose Registry Support Services has helped its client facilities to implement an effective, low-cost dose monitoring program and meet The Joint Commission’s requirement to establish Expected Dose Ranges and then identify the exams that exceed their expected range, avoiding the need to purchase expensive third-party solutions. One hospital system estimated our approach saves them $80,000 to $100,000 per year.

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Here are recent examples of the successes two of our sites reported to their radiation safety committees.

This first example is a chart showing one facility’s average monthly Total DLP for its Chest Angio studies from early 2016 through Q1 2018. Overall, this site reduced its average Total DLP for its Chest Angio studies by 38%. Note the stepwise dose reduction.

The second example shows how another site reduced its Total CTDIvol for Routine Neck studies by 67%. Each point in the chart below represents an actual study. Perhaps even more striking is the remarkable reduction in inter-study variability in recorded Total CTDIvol.

Unlike some other dose monitoring and reduction solutions that are confusing and complicated to use, and leave you largely on your own after installation, Dose Registry Support Services works directly and personally with staff to identify and investigate dose reduction opportunities on an ongoing basis; and we do so at only 10% to 15% of the cost of many third-party solutions. Also our service does not require the facility to add staff or devote a partial (or full) FTE.

Additionally, because we work in a collaborative fashion with the facility’s staff, radiology department staff remain involved in the process, learn from their involvement, and are able to take (and own) these successes to the safety committee. In short, ours is more of a service that works with you and your staff than a product – a service that works with you and your staff to reduce CT doses.

If you are considering purchasing a third-party solution, or if the solution you purchased is sitting unused in the corner because it is overly complex, you may want to consider having us help you. We make you better.

When the facility I was working with was exploring using their scanners’ XR-29 Notifications to meet PI 02.01.01.A6 Dose Incident Identification requirements we reviewed the technical elements underpinning XR-29’s Dose Check feature. After reading them we grew very concerned that XR-29’s dose notifications would not meet TJC’s requirement. The facility submitted a question to TJC asking about this specific issue. We were correct to be concerned; TJC’s response indicated XR-29 Dose Notifications don’t meet the requirements. Here is a copy of their response:

TJC requires facilities establish the expected total dose ranges (CTDIvol, DLP, or SSDE) for each protocol and then test the actual total dose imparted after the exam has been completed to the protocol’s expected total. The total is across all irradiation events; this includes the sum of the pre-monitoring, bolus tracking, and then actual scan series dose values. In the image below that equates to the Total DLP at the top of the image or the sum of the doses listed in the CTDIvol values column.

There are several ways of complying with TJC’s dose incident identification requirements, some expensive, some free or nearly so.

You may get lucky and have TJC auditors that don’t yet understand the technical aspects of dose monitoring. However, this facility did not want to take that chance. Dose Registry Support Services can provide facilities with a very low-cost, fully TJC compliant program using your DIR data and avoid the expense of purchasing and then operating a third-party software solution.